ICI 204, 636: A New Atypical Antipsychotic Drug

1996 ◽  
Vol 168 (S29) ◽  
pp. 45-56 ◽  
Author(s):  
Steven R. Hirsch ◽  
Christopher G. G. Link ◽  
Jeffrey M. Goldstein ◽  
Lisa A. Arvanitis
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drug ◽  
Antipsychotic Agents ◽  
Pharmacological Action ◽  
Therapeutic Effects ◽  
Typical Antipsychotic ◽  
Extrapyramidal Side Effects ◽  
Dopaminergic Receptors ◽  
Atypical Antipsychotic Drug

The therapeutic effects of ‘classic’ (typical) antipsychotic agents lie in their ability to block central dopaminergic receptors – a property that is also responsible for the frequent occurrence of undesirable extrapyramidal side-effects (EPS). In contrast to these typical agents, clozapine alone has distinguished itself in humans – by virtue of its enhanced antipsychotic action and lack of concurrent EPS – as an atypical antipsychotic. However, the use of clozapine has been limited by the occurrence of agranulocytosis and, to a lesser extent, seizures (Alvir et al, 1993; Haring et al, 1994). The mechanism underpinning the atypical profile of clozapine remains elusive. One hypothesis suggests that it lies in clozapine's higher serotonin 5-HT2: D2 binding ratio, when compared with typical agents – a factor being considered as a predictor of atypicality (Meltzer, this issue; Meltzer et al, 1989). However, an emerging view is that it is not a single pharmacological action, but rather multiple properties that may define an atypical, clozapine-like compound (Lieberman, 1993).

Psychopharmacology of olanzapine

1999 ◽  
Vol 174 (S38) ◽  
pp. 52-58 ◽  
Author(s):  
C. M. E. Stephenson ◽  
L. S. Pilowsky
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drug ◽  
Therapeutic Efficacy ◽  
Atypical Antipsychotics ◽  
Extrapyramidal Side Effects ◽  
Atypical Antipsychotic Drug ◽  
Blood Monitoring

The development of atypical antipsychotics has revolutionised the treatment of schizophrenia, as well as providing new insights into its cause. The archetypal atypical antipsychotic is clozapine, which has therapeutic advantages over traditional antipsychotics, as well as a low potential for producing extrapyramidal side-effects (EPS) (Kane et al, 1988). However, clozapine causes agranulocytosis in 1% of patients, and there has consequently been a search for novel atypical antipsychotics, as efficacious as clozapine, but without the need for intensive blood monitoring. There has been much discussion of the definition and characteristics of an atypical antipsychotic drug, and an operational understanding seems to have been agreed upon, that atypical drugs have therapeutic efficacy in treating schizophrenia, without producing EPS (Deutch et al, 1991; Kerwin, 1994).

Deterioration of parkinsonian symptoms following treatment of dopaminergic hallucinosis with olanzapine

1999 ◽  
Vol 14 (6) ◽  
pp. 356-357 ◽  
Author(s):  
J. Rudolf ◽  
M. Ghaemi ◽  
S. Schmülling
Keyword(s):  
Parkinson’S Disease ◽  
Side Effects ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drug ◽  
Extrapyramidal Side Effects ◽  
Atypical Antipsychotic Drug ◽  
Extrapyramidal Syndrome ◽  
Olanzapine Treatment ◽  
Dopaminergic Psychosis ◽  
Paranoid Symptoms

SummaryThe atypical antipsychotic drug olanzapine has been proposed for treatment of dopaminergic psychosis in Parkinson's disease (PD). We report on a 68-year-old patient who developed a severe akinetic-rigid extrapyramidal syndrome, accompanied by additional paranoid symptoms, following olanzapine treatment of optic hallucinosis in PD. Olanzapine may also induce clinically relevant extrapyramidal side effects in PD patients.

The assessment and management of treatment-resistant schizophrenia in perspective

1995 ◽  
Vol 10 (S1) ◽  
pp. 3s-5s ◽  
Author(s):  
HY Meltzer ◽  
H Hippius
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drugs ◽  
Subjective Evaluation ◽  
Treatment Resistance ◽  
Antipsychotic Agents ◽  
Therapeutic Effects ◽  
Extrapyramidal Side Effects ◽  
Clozapine Treatment ◽  
Results Of Treatment

SummaryConsensus was reached on the five following points: (1) “Treatment resistance” is a term which is widely used, but not adequately defined. In particular, definitions of “responders” and “non-responders” need to be more precise. (2) There is a need to extend the assessment of the results of treatment to include factors such as quality of life and the subjective evaluation by the patient and relatives. (3) Clozapine (Clozaril®/Leponex®) has become the standard for atypical antipsychotic drugs. The adjective “atypical” is not an exact descriptor. The vague nature of the term leads to confusion with other drugs that are putative atypical antipsychotic agents but have different properties. D2 dopamine receptor antagonism is the single factor common to all antipsychotic drugs. Antagonism at a specific D2-like receptor may underlie the atypical antipsychotic actions of clozapine. Drugs described as being atypical antipsychotics share a relatively low incidence of extrapyramidal side effects. (4) Clozapine is the only drug that produces antipsychotic (therapeutic) effects at doses that do not result, in significant extrapyramidal side effects. This may be due to the fact that antipsychotic efficacy is obtained with clozapine in doses that result in significantly less striatal D2 occupancy. Other factors including concomitant 5-HT2 antagonism, may contribute to the lack of motor side effects observed with clozapine treatment. (5) Clozapine is the only drug currently well proven in therapy-resistant schizophrenia, and there is a case for its earlier use in patients who can be anticipated to become therapy resistant. Other antipsychotic therapies remain unproven in this group of patients.

scholarly journals Rapid tranquillisation: Time for a reappraisal of options for parenteral therapy

2002 ◽  
Vol 180 (06) ◽  
pp. 485-489 ◽  
Author(s):  
R. Hamish McAllister-Williams ◽  
I. Nicol Ferrier
Keyword(s):  
Side Effects ◽  
Sudden Death ◽  
Atypical Antipsychotic ◽  
Antipsychotic Medication ◽  
Antipsychotic Agents ◽  
Parenteral Therapy ◽  
Extrapyramidal Side Effects ◽  
Selective Review ◽  
Atypical Antipsychotic Agents ◽  
Current Guidelines

BackgroundWhen parenteral treatments are indicated for acutely disturbed behaviour, previous guidelines have recommended droperidol or haloperidol in combination with benzodiazepines. However, there has been recent concern over cardiotoxicity and sudden death associated with some antipsychotic medication and droperidol has now been withdrawn.AimsTo ascertain what alternatives can be recommended to replace intramuscular droperidol.MethodSelective review of current guidelines and the literature pertaining to rapid parenteral tranquillisation.ResultsCurrent guidelines recommend haloperidol as an alternative to droperidol. There is evidence of cardiotoxicity with haloperidol and it has a propensity to cause extrapyramidal side effects that may exacerbate disturbed behaviour and reduce longer-term compliance. The rapid-acting intramuscular formulations of atypical antipsychotic agents show promise.ConclusionsIt is recommended that the mainstay of pharmacological rapid tranquillisation should be parenteral benzodiazepines used with due care.

scholarly journals Trends of Anticholinergics and Antipsychotics Prescribing at Chainama Hills College Hospital, Lusaka-Zambia

2021 ◽  
Vol 3 (2) ◽  
pp. 24-31
Author(s):  
Francisca T Bwalya ◽  
◽  
James Mwanza ◽  
Paul Ravi ◽  
◽  
...  
Keyword(s):  
Side Effects ◽  
Atypical Antipsychotic ◽  
Treatment Guidelines ◽  
Anticholinergic Drug ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Anticholinergic Drugs ◽  
Typical Antipsychotic ◽  
Extrapyramidal Side Effects ◽  
College Hospital

Introduction:Antipsychotics are the main pharmacological treatment for psychosis. Anticholinergic drugs are sometimes prescribed with antipsychotics to treat or as prophylaxis for extrapyramidal side effects. Antipsychotic treatment guidelines recommend that anticholinergics should not be prescribed indiscriminately as prophylaxis for extrapyramidal side effects to patients using antipsychotic drugs, but only when there is high risk or evidence of extrapyramidal side effects, as they can cause significant central and peripheral side effects which have a potential to affect treatment outcomes. The objective of the study was to assess the trends in the prescribing of antipsychotics and anticholinergics.Methods:A cross sectional study was conducted at Chainama Hills College Hospital in Zambia. An open-ended questionnaire was administered to 26 prescribers and 311 files for patients were reviewed who had an antipsychotic or anticholinergic drug prescribed. The prescription pattern of patient files was compared with theNational Institute for Health and Care Excellenceguidelines as a gold standard.Results:The antipsychotic distribution showed that 76.1% were prescribed a typical antipsychotic, 18.1% an atypical antipsychotic and 5.8% were on both typical and atypical antipsychotic. 28.2% of the patients on antipsychotics were prescribed anticholinergics (Trihexyphenidyl). 46.2% of the prescribing clinicians stated that they prescribe anticholinergics when a patient develops extrapyramidal side effects rather than concurrently with antipsychotics or when a high dose of antipsychotics has been prescribed.Conclusion:The trend in antipsychotic and anticholinergic prescribing in Lusaka-Zambia were not consistent with recommended guidelines. Majority of patients are on typical antipsychotics rather than atypical antipsychotics. Most patients were administered above optimal dose of antipsychotics though polypharmacy was solemnly practiced. Recommend that further studies to explore factors contributing to this trend are conducted.

Are Atypical Antipsychotic Drugs also Atypical Antidepressants?

2001 ◽  
Vol 35 (5) ◽  
pp. 631-638 ◽  
Author(s):  
Gordon Parker ◽  
Gordon Parker ◽  
Gin Malhi
Keyword(s):  
Atypical Antipsychotic ◽  
Antipsychotic Drug ◽  
Antipsychotic Drugs ◽  
Case Series ◽  
Antidepressant Activity ◽  
Typical Antipsychotic ◽  
Treatment Resistant ◽  
Melancholic Depression ◽  
Atypical Antipsychotic Drug ◽  
Atypical Antipsychotic Drugs

Objective: To report a case series and review the psychopharmacology of the neuroleptic drugs to suggest that the atypical antipsychotic drugs may have an antidepressant action, at least for those patients with the melancholic subtype. Method: We note the literature suggesting that the older (or typical) antipsychotic drugs were established as having antidepressant activity, describe an open study of some two dozen patients with a treatment-resistant melancholic depression, describe rapid resolution of depression and augmentation benefits associated with commencing an atypical antipsychotic drug in a percentage of subjects, and then review relevant psychopharmacological studies to consider whether there is a rationale for use of antipsychotic drugs to treat depression. Results: Of some two dozen patients treated with an atypical antipsychotic drug, almost immediate improvement was noted in four patients, and evidence of augmentation benefit obtained in another three patients. Conclusions: Impressions from this case series are encouraging. However, as open clinical observational studies are problematic, controlled studies are required to establish whether the atypical antipsychotic drugs have a role in the management of certain expressions of depression, and, in particular, treatment-resistant melancholic depression.

scholarly journals Trifluoperazine induced blepharospasm: a case report

2017 ◽  
Vol 4 (3) ◽  
pp. 867
Author(s):  
Indu Dhiman ◽  
Umesh Dhiman ◽  
Tarun Sharma ◽  
Aradhna Sharma
Keyword(s):  
Case Report ◽  
Atypical Antipsychotic ◽  
Antipsychotic Drug ◽  
Unusual Case ◽  
Typical Antipsychotic ◽  
Atypical Antipsychotic Drug ◽  
Drug Induced

We hereby report an unusual case of trifluoperazine (typical antipsychotic drug) induced tardive blephrospasm which was relieved subsequently after dechallenging the drug. Thereafter patient was started with clozapine (atypical antipsychotic drug). This possibility of blepharospasm should always be kept in mind while prescribing trifluoperazine.

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